Atherosclerotic cardiovascular disease


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Arteriosclerotic cardiovascular disease; ASCVD; ASHD; Myocardial infarction; MI; Ischemic heart disease; IHD

Biomedical References

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Atherosclerosis is clinically silent as arterial intimal plaques develop over years and decades. Atherosclerosis is the underlying cause in approximately 90% of myocardial infarctions, 60% of strokes, most cases of heart failure, and up to one third of all cases of dementia. Established risk factors for coronary artery disease and stroke are hypertension, diabetes, dyslipidemia, smoking, obesity, physical inactivity, kidney dysfunction, left ventricular hypertrophy, alcohol, and atrial fibrillation. [Cecil, p. 409; 257] "The lifetime risk of coronary artery disease after age 40 is 49% in men and 32% in women. The percentage of cases that are occupationally related is not known." Carbon monoxide (CO) and solvents may trigger ischemia in workers with underlying atherosclerosis. Good evidence associates CO, carbon disulfide, and nitrates with ischemic heart disease IHD), while strong evidence associates exposure to PM2.5 in air pollution with cardiovascular morbidity and mortality. The evidence associating stress, noise, lead, and arsenic with IHD is limited. [APHA, p. 291] "In conclusion, occupational PM [particulate matter] exposure may be associated with IHD mortality and MI. There is also evidence that occupational PM exposure is associated with decreased heart rate variability, a risk factor for CVD mortality and which may be a potential mechanism of PM-associated adverse cardiovascular events and stronger evidence across study cohorts of an association with systemic inflammation, also a potential mechanism of PM-associated IHD. Though data is currently lacking to determine causality, findings from this review justify a greater recognition of the risk of both the development and aggravation of CVD from occupational exposure to PM." [Reference Link] "Whether atherosclerosis is accelerated at levels of carbon monoxide commonly encountered in the workplace is unclear." [LaDou, p. 388] Mean black smoke concentrations fell by 35 ug/m3 after a 1990 ban on sale of coal in Dublin, Ireland. Cardiovascular deaths fell about 10% after this intervention comparing rates in the 3 years before and after the ban. [PMID 12401247] In Ireland, the 98th percentile limit for black smoke (BS) was 250 ug/m3. In 2005 when average levels of BS were below 20 ug/m3, the BS limit was replaced with a PM10 daily mean limit of 50 ug/m3. [www.epa.ie] "With reference to morbidity from respiratory and cardiovascular diseases, European studies in adults do not provide consistent evidence of an association between PM exposure and chronic bronchitis or asthma, nor cardiovascular conditions. Studies on PM10 and lung function, on the other hand, reported positive results." [PMID 19995424] Based on Swedish mortality in 2007, an estimated 800 work-related deaths per year occurred. "The majority are due to acute myocardial infarction, with 126 deaths among women and 337 deaths among men attributable to job strain, shift work, exhaust gases, combustion products, or environmental tobacco smoke (ETS)." [PMID 22358144] See "Ischemic heart disease mortality and PM(3.5) in a cohort of autoworkers." [PMID 23280679] See "Particulate matter." See "Carbon disulfide, chronic toxic effect."


In the Framingham Heart Study, major risk factors were total cholesterol =240 mg/dL, systolic pressure =160 mmHg, diastolic pressure =100 mmHg, smoking, and diabetes. Exercise testing may enhance the predictive value. [UpToDate: Estimation of CV Risk]

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Reference Link

A systematic review of occupational exposure to particulate matter and cardiovascular disease.

Related Information in Haz-Map

Hazardous agents that cause the occupational disease: